Commentary on the economic , geopolitical and simply fascinating things going on. Served occasionally with a side of snark.

Saturday, February 15, 2014

Obamacare thread February 15 - February 21 , 2014.....White House weighing plan to extend ObamaCare’s “risk corridor,” i.e. bailout, program beyond 2016 ? Pelosi: No, there won’t be a mandate delay for the little people because this is sound policy ........ on the hustle for the young bodies needed to prop up Obamacare......Obamacare layoff quandary ..... pass the buch to 2016 game in process.....Will the next government " mandate " be that all doctors participate in Obamacare ?

POSTED AT 4:41 PM ON FEBRUARY 18, 2014 BY ALLAHPUNDIT

Industry insiders told the Washington Examiner a plan to extend the Affordable Care Act’s “risk corridors” are under discussion, but that administration officials have not made a final decision…

The Obama Administration is now weighing a plan to grant an additional three-year extension for non-complaint plans on the individual market. Such a move would prevent millions of people from losing their policies in the critical weeks and months before the 2014 election.

But it would also allow people on the individual market to keep non-compliant plans beyond the risk corridor’s 2016 expiration date, leaving health insurance companies serving the exchange vulnerable to financial losses as the more healthy customers continue to stay out of the exchanges.

Health insurance companies are looking for something in exchange for the three-year extension, which will make it much harder for them to sign up healthier and younger customers. Extending the risk corridor program is part of that conversation with the White House, industry sources said.

Remember back in November when Obama was eating truckloads of crap for breaking his “if you like your plan” promise? His solution was to let insurers “un-cancel” canceled plans — but lost in the hubbub at the time was the fact that he said he’d allow it for just one year. The obvious problem with that timeline is that it means this issue will bubble up again this fall, just in time for the midterms. New solution, then: Quietly allow insurers to keep un-canceled plans in effect past the midterms, for another three years. That’s how Obama just “solved” his little electoral problem with the employer mandate, isn’t it? Three-year extensions across the board, to minimize the damage to Democrats from his pet boondoggle in November. The problem is, because the old un-canceled plans are typically cheaper than expensive new “comprehensive” ObamaCare exchange plans, the extension means insurers are suddenly looking at less revenue than they counted on all the way through 2017. That’s where the “risk corridors” come in. Assuming the Examiner’s report is true, the White House is going to make this worth the industry’s while by extending the timeline for the bailout program too. Any losses they suffer in 2017 would, presumably, be partly offset by Uncle Sam even though the “risk corridor” is supposed to have terminated by then. Your tax dollars will buy insurers’ complicity in yet another illegal extension.

Bob Laszewski kinda sorta saw this coming, by the way. Last month he published a post arguing that, for all its faults, ObamaCare won’t cause a death spiral in the insurance industry anytime soon. The reason: The “risk corridor” program. Since Uncle Sam’s on the hook for any heavy losses in the industry, insurers are under no immediate pressure to raise premiums, the potential trigger of a death spiral. They can keep premiums artificially low — at least for a few years, until the “risk corridor” sunsets. Laszewski figured insurers would give the White House one more chance next year to get their act together on implementation and to start signing up the uninsured en masse; if they failed, he said, he expected companies to start parachuting out of the exchanges in 2016 before the “risk corridor” program expires. Which is to say, it’s very much in the White House’s interest to keep the program in effect, if it can, to keep insurers from abandoning the exchanges, especially if HHS has reason to think the risk pools they’re projecting will be less young and healthy than they had hoped. (And they do have such a reason at the moment.) The last thing Democrats need in a presidential election year is “Insurers give up on ObamaCare” headlines. Promise them some more sugar and you can avoid that. Maybe.

It seems naive at this point to ask whether the White House could extend the “risk corridor” unilaterally or whether that would be illegal. If they want to do it, they’ll do it regardless. O’s theory in issuing periodic delays or extensions for ObamaCare’s provisions is that, during the law’s transitional phase, he has some latitude legally to tweak implementation to make it go more smoothly. Extending the “risk corridors” past 2016, though, would mean the “transitional” phase had lasted past the end of his own presidency. It’s dubious, but it’s also in character. Here’s a question, though: Why would insurers leak this info now, when Marco Rubio’s trying to build support within the GOP for a bill to repeal the “risk corridor” program? He’s had little luck getting it on the leadership’s radar but his luck could change now that rumors are swirling that the bailout provisions might be extended into 2017 and beyond. The recent CBO numbers that found that the “risk corridor” could actually make money for taxpayers is a problem for the GOP, but (a) CBO’s numbers can be challenged and (b) CBO assumed that the “risk corridor” would be gone by 2016. Even if O decides to unilaterally extend the program, a new Republican Senate next year could join forces with some red-state Dems and Boehner’s House majority to repeal it, forcing Obama to either acquiesce in the repeal or to veto it and be seen as singlehandedly defending indefinite bailouts for insurers. Very strange that insurance industry sources, who stand to benefit, would be blabbing about this now.

Pelosi: No, there won’t be a mandate delay for

the little people because this is sound policy

POSTED AT 7:21 PM ON FEBRUARY 14, 2014 BY MARY KATHARINE HAM

A variation on the “you’re gonna love it once it’s fully enacted” chorus of fibs we’ve been hearing since this thing was passed in 2009. It isn’t really news, per se, that Rep. Nancy Pelosi is willing to support a pass for employers for this law that doesn’t go to individuals about to be hit with the mandate tax. It’s not news that she’s willing to ignore the many failings of the law and its implementation and refer to it as utterly “sound policy,” even as the worst Jenga tower every constructed is crumbling before her. But it is illustrative of the Democratic plan to put blinders on and say “but, but, we passed a law!” when faced with the unfairness of the system they’ve created and the waivers they’re granting. It’s also illustrative of how lazy an answer Democrats offer on this stuff. “It’s a totally different issue,” she says. Well, that settles that. Enjoy your sound policy. Unless their sound policy took your formerly sound policy away.

For more on the lazy answer front see this from Sen. Joe Manchin, who thinks we should delay the whole thing. Imagine that!

“You’re just picking and choosing,” the West Virginia Democrat said of the administration’s decision. “First it’s basically the large employers, then it’s medium groups, then it’s 50 to 100 — medium-sized. If there’s a problem, there’s a problem.” He said there’s bipartisan support for legislation postponing the implementation of the entirety of the Affordable Care Act until 2015. “We’re sure in a transition period and they keep changing the dates,” the senator said, frustrated. “So I wish everyone would come to grips.”

“I think it’s more important than we get it done right than fast,” she told NRO. “So I support the president’s decision. Typically these businesses that have to negotiate and — so I support the president’s decision.”

When I asked her if she thought it was valid to argue that delaying the employer mandate but not the individual one favors companies over individuals, she said, “I think I support the president’s initiative.”

And, Sen. Jon Tester:

“You know, it’s probably the right thing to do,” he told NRO. “I mean, he probably looked at some metrics that caused him to make that decision. The rollout was rocky, everybody knows that.”

These are the people writing the “sound policy” that would shape a sixth of the American economy. What could go wrong (that hasn’t already) ?

Obamacare enrollment push for the young enters 11th hour

The federal government forms for applying for health coverage are seen at a rally held by supporters of the Affordable Care Act, widely referred to as ''Obamacare'', outside the Jackson-Hinds Comprehensive Health Center in Jackson, Mississippi October 4, 2013.

CREDIT: REUTERS/JONATHAN BACHMAN

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(Reuters) - One of the latest Obamacare pitches to get young adults to sign up for health insurance starts out with a mother's kitchen note reminding her grown son to enroll.

"Mom, you know I can't afford it," the young black man protests, as he sits down at a kitchen table next to a bespectacled woman with a laptop computer linked to the U.S. federal enrollment website, HealthCare.gov.

"But for the first time you can," she replies reassuringly. "You go to the HealthCare.gov website, compare quality plans and you could get help paying for it."

The government-sponsored television ad, which is airing on five national cable-TV channels, including ABC Family and TVLand, is part of an uphill battle to increase youth participation in President Barack Obama's signature domestic policy achievement. Youth participation in the program is a key factor in whether the program succeeds or fails in its first year.

U.S. government data released this week show the demographic of adults aged 18-34 rose only slightly by the end of January to 25 percent of total enrollment in private Obamacare plans.

That is well below the 38 percent that administration officials have talked about achieving to give insurers a strong mix of healthier members, whose premium payments help offset the cost of older, sicker policyholders.

Several top insurers have expressed unease about the mix of enrollment so far, and Republican opponents of the law see weak youth participation as the start of a downward spiral that will put the government on the hook for more spending to keep it alive.

The Obamacare marketing push has already been delayed repeatedly by the botched rollout of HealthCare.gov in October, requiring the administration to focus its efforts on fixing the website. Given those delays, experts say the Obamacare marketplaces could have trouble getting much above the 30 percent mark by the time enrollment ends on March 31.

Obamacare's advocates from the White House to federal and state agencies, health insurers, hospitals and grassroots nonprofit groups are launching the final push on Saturday, with what they call National Youth Enrollment Day.

"We're entering the sprint to the end," said Aaron Smith, executive director of Young Invincibles, a nonprofit group that is spearheading youth outreach.

The Centers for Medicare and Medicaid Services, the federal government's lead Obamacare agency, allocated $52 million for paid media in the first three months of 2014.

The campaign has already had help from singers Lady Gaga and John Legend and actress Olivia Wilde. Focus is now on sports celebrities including former professional basketball star Magic Johnson, who appears in a promotion alongside this week's OlympicGames. CMS will also run ads during the hugely popular college basketball playoffs known as March Madness.

Administration officials say young adults are only one audience for the effort. But the campaign is targeting 25 U.S. metropolitan areas that are home to 5 million uninsured young adults, according to a Reuters analysis of U.S. Census data.

"There's a variety of tactics," said Marlon Marshall, deputy director of the White House Office of Public Engagement. "All of those things add up to one big echo chamber. And that echo chamber is going to grow."

Health insurers are expected to fork out millions more to advertise their plans. Nonprofit groups Enroll America and the nonpartisan Ad Council have a $30 million TV campaign with singing pets.

The campaign competes with counter-messaging from Republicans and other Obamacare critics including Generation Opportunity. The young conservatives group sought to discourage enrollment last year with viral online videos picturing young men and women cornered in intimate medical settings by a creepy Uncle Sam puppet. The group says it is planning "a barrage of efforts," which it declined to detail.

CONCERN OVER PRICE HIKE

Obama's Patient Protection and Affordable Care Act barred longstanding insurance market practices that imposed sharply higher prices on people who were sick or older. That puts the onus on the program to spread insurers' risks between policyholders who need lots of medical attention and younger consumers who tend to be healthy and cheaper to insure.

The concern is that the fewer young adults sign up, the higher insurance costs may have to rise for 2015.

A Massachusetts health insurance marketplace, launched in 2007 under former Republican Governor Mitt Romney and widely seen as the prototype for the Obamacare exchanges, took nine months to breach the 30 percent mark, according to an analysis by Jonathan Gruber, an MIT professor and an architect of Obamacare and Massachusetts' earlier reforms.

Gruber and other experts say reaching about 30 percent participation is a more reasonable goal for Obamacare in 2015 than 2014 given its challenges, including bitter partisan opposition, scant funding, and a public that is largely misinformed about the law and the botched HealthCare.gov launch.

"It's going to take two or three years minimum to do what Massachusetts did," said Brian Haile, senior vice president for health policy at Jackson Hewitt Tax Service Inc., a tax preparation service that is promoting Obamacare enrollment.

Analysts at the nonpartisan Kaiser Family Foundation maintain that even if youth enrollment remains unchanged at 25 percent, it would add only 2.4 percent to 2015 premiums because the law compensates insurers for unexpected losses.

Obamacare's allies cite some distinct advantages. For one thing, their youth enrollment push is getting under way just as the Internal Revenue Service distributes hundreds of billions of dollars in tax refunds that could provide the cash for initial premium payments, experts say.

The relatively low income rates for young adults are also expected to make them some of the biggest recipients of government tax credits and other subsidies to buy coverage. Census data show 27 percent of America's 18.4 million adults aged 19 to 34 have no insurance, while mean earnings range as low as $15,800, versus $46,000 for the overall population.

"By far, the biggest sweet spot is younger people. They are absolutely eligible for the largest subsidies. Many of them though are individuals who haven't had insurance before," said Peter Lee, director of California's healthcare exchange.

Standing outside Madison Square Garden in New York on a bitter February night, Steven Abramson had little luck attracting young people with flyers that read "NEED Health Insurance?" to fans headed to watch the New York Knicks take on the Portland Trail Blazers.

The few women who did stop to take the pamphlets couldn't speak English.

"The generation of older people understand the need for health insurance, but with younger people, we have to convince them to sign up, even though it is the law," said Abramson, a volunteer with the Obama group Organizing for Action.

Yesterday, the Obama administration announced health insurance enrollment figures for January. Here’s the rundown, for those of you who missed it:

Almost 3.3 million people signed up for a policy as of Feb. 1. January projections actually slightly exceeded their target. That’s good news for the exchanges.

Most people are choosing mid-range silver plans, rather than bare-bones catastrophic or bronze level plans (which is what many analysts had expected them to buy). This could be in part because people do seem to prefer more generous coverage, but is probably also due to the availability of special cost-reduction credits to people with incomes between 100 percent to 250 percent of the federal poverty line if they buy silver plans.

The number 3.3 million represents people enrolled in a policy, not the number who have paid for their premiums. Most of the reporting -- which comes from insurance industry sources -- suggests that about 80 percent of those who signed up have actually paid the first month’s premium. That would put actual enrollees at more like 2.64 million. The administration now seems unlikely to hit the Congressional Budget Office’s projection of 6 million total enrolled (and paid). If enrollment and payment continue at January’s pace, they will end up under 4.8 million. That’s not necessarily the most likely outcome: We could see a surge in March, like the one we got in December. But it’s a real danger.

The demographic mix isn’t improving as hoped. In order to maintain an actuarially sound pool, and keep premiums down, the exchanges were supposed to have 40 percent of their customers between the ages of 18-34. The demographics slightly improved in January, but young adults still make up only 25 percent of the market.

A lot of people are getting subsidies -- as expected. About 80 percent of the folks who bought policies on the exchange so far were eligible for subsidies. That seems high, but it’s roughly in line with estimates from the CBO, which showed six out of seven enrollees getting at least some subsidy from the federal government.

We still have no idea how many of these people previously had insurance. If the administration knows, it is not sharing those numbers with anyone else.

http://nypost.com/2014/02/14/a-mandate-for-layoffs/

The White House has just made a damning admission about ObamaCare: Its employer mandate creates an incentive for businesses to lay off workers.

That’s not how the administration puts it, of course. But a new rule requiring certain businesses to certify — on pain of perjury — that layoffs they make are not ObamaCare-related rests on this assumption.

This new requirement is a byproduct of the decision to extend for yet another year the waiver of the health insurance mandate for businesses with 50-99 employees. Obviously this gives businesses an incentive to get out of the mandate by getting under the 100-employee threshold.

As Andrew McCarthy notes on National Review Online, there’s nothing illegal about laying off employees over tax-related consequences. And as Chief Justice John Roberts has ruled, ObamaCare is a tax.

Yet any business that won’t certify that its layoffs are due to “bona fide business reasons” won’t be eligible for what the IRS calls “transition relief” — i.e., the extra year of the mandate waiver. And the agency has set out a list of what it considers legitimate excuses. Basically, as long as it isn’t because of ObamaCare, a business can lay off as many people as it wants.

The list of what does and doesn’t qualify as a legitimate layoff suggests another danger here: an IRS readying itself to investigate businesses whose payrolls slip below the magic number. And you thought Lois Lerner was bad.

In short, after long denying ObamaCare would lead to job losses, the administration now has to threaten criminal sanctions and IRS investigations to make sure it doesn’t.

The embattled HealthCare.gov site features a time line for implementation of the Affordable Care Act. It ends in 2015.

They wish.

If there was any chance that health care reform would soon feel more like the law of the land and less like a piñata that gets refilled and rehung daily, the White House essentially put that notion to rest this week when it punted the deadline for medium-sized employers to comply with the law yet another year.

Now, businesses with 50 to 100 employees have until 2016 to offer their workers affordable insurance or pay a penalty—just about the time presidential primary season is getting underway and this president is rendered an afterthought.

The policy effect of the delay on the ACA is minimal, most experts say. But in the political battle over Obamacare, now in its fifth smash year, the news was one more indication that the front has moved to the next presidential election and beyond to the incoming administration.

The law "will be on the front burner in Washington and in every Republican campaign through 2016," predicts Patrick Davis, a GOP consultant in Colorado.

That election likely will mark the fourth straight election cycle in which the ACA is a major issue, if not the central issue—an eternity in politics. Call it Obama's Forever War. "It's the gift that just keeps giving," says Douglas Holtz-Eakin, the former chief of the Congressional Budget Office during the Bush administration, who launched a conservative health care think tank last month.

Holtz-Eakin is among many critics who viewed the delay of the employer mandate as a means for the White House to avoid ugly headlines. The requirement at least raises the possibility that, faced with the deadline, businesses will hire fewer full-time workers or, more dramatically, deep-six their health care coverage outright and dump workers into the ACA's insurance exchanges.

Supporters of the law have long insisted that won't happen, but kicking the mandate down the road is one way to help ensure that if that does occur in large degrees, it might be Hillary Clinton's problem, not President Obama's.

In the meantime, the drip-drip-drip of Obamacare's ups and downs remains a preoccupation of both Republican message-makers and the Washington press corps. Along with the mandate delay, the last week has seen a furious battle over a CBO report about the effects of the law on the labor force and more close-quarter combat about the total number of enrollees on the exchanges.

The ACA continues to devour far more political oxygen than it should given the relatively few Americans it currently affects. There was, not that long ago, a thought that the exchange rollout might cement the ACA's place in the firmament. But theHealthCare.gov fiasco scrambled that calculation. Now, says Holtz-Eakin, "there's no end in sight."

Politically, the White House and vulnerable Democrats in Congress have rocking on their heels ever since. Something like the mandate delay emboldens Republicans who believe—whether it's sound strategy or not—that the law is vulnerable to renewed attack.

"Every time the administration gets cute and thinks they can manage Obamacare as a political liability with a delay, they basically ensure that action provides Republicans with yet another opportunity to drive a contrast before voters," says Kevin Madden, a former Mitt Romney adviser who now works as a GOP strategist.

Such delays, frets Democratic Leadership Council founder Al From, reinforce the view that the federal government simply isn't up the task of working out the details of large-scale reform, weakening his party's argument for continued control of the White House. "When people have no faith in government, they vote Republican," he says.

And in another sign that the GOP is thinking about 2016, party leaders have been re-tailoring their political message, using fewer scare quotes to rally the base and framing the argument against the ACA in Reaganesque phrases about entitlement versus work. Witness Rep. Paul Ryan's comments last week about the law being a "poverty trap" that robs people of the "dignity of work."

On a policy level, the shaky start means that it will take even longer for the benefits of the law, including whether the plans available under the exchanges are worth the cost, to reveal themselves to the majority of Americans who remain skeptical.

Two or three years at a minimum, says Drew Altman, president and CEO of the Kaiser Family Foundation. "There will be implementation land mines for a very long time" allowing Republicans to chip away at the law's foundation by what Altman calls "death by anecdote."

The first benchmark will come this spring if the administration fails to meet its own goals for enrollment and for the mix of the young and healthy to the risk pool. While analysts say the make-up of the federal pool is rather insignificant compared with the composition of state pools, GOP critics won't hesitate to pounce on the shortfall.

Another involves the now-delayed employer mandate. Since employers are not yet required to certify that they offer their employees coverage, that means there's no way to verify whether those workers are eligible for subsidies on the exchanges. (It's been called an "honor system.") That will, Holtz-Eakin says, inevitably lead to cases of fraud uncovered by the media.

A third and more potentially troublesome flashpoint will come closer to midterm Election Day, when consumers and small businesses face another round of policy cancellations in advance of 2015. Many businesses locked in their 2014 rates early last year in fear of the ACA—and some could experience steep premium hikes. That could damage Democratic prospects for retaining Senate control at a critical time.

It's a cascade effect. A GOP takeover of the Senate would then ensure Congress would be in full anti-ACA mode through the 2016 campaign, passing legislation that likely would be vetoed by Obama. "It guarantees two more years of this," says Mo Elleithee, spokesman for the Democratic National Committee.

Obamacare will haunt Democrats in other ways by then. When the White House delayed implementation of the so-called "Cadillac" tax on high-dollar health care plans to 2018 because of union objections, it ensured that the next wave of candidates for president will be under heavy pressure to pledge to repeal the tax as a condition for labor support. Doing so would renew cries of favoritism and selective enforcement that are dogging Obama now. The same would happen if the White House decides, as some have speculated, to scrap the employer mandate outright before it does any harm.

And if Clinton runs, she'll have to run as the architect of the individual mandate, the requirement that everyone purchase health insurance. (Obama basically co-opted that aspect of her plan.) Should a challenger "take even one step away from the mandate inside a Democratic primary," Kevin Madden says, "the party would fracture."

None of this means continually hammering away at the ACA for the next three years will secure the White House for the GOP. Elleithee, naturally, sees it as a political loser. And Democratic strategist Steve McMahon contends time is needed for the political narrative to be rewritten. "The boogeyman stories always seem to punch through," he says. The law "will get there eventually."

Remember that ACA timeline? It's growing longer by the minute.

http://www.nationalreview.com/article/371105/doctors-oath-marc-siegel

FEBRUARY 14, 2014 4:00 AM

A Doctor’s OathGovernment may be poised to mandate that all doctors participate in Obamacare.

For me and many other doctors like me, taking care of you has never been about the money. I have always considered it an honor and a privilege to be allowed personal entrance into the private world of your mind and your body. It is very satisfying for me to be able to offer my medical knowledge and experience to help you, my patient. This is why no matter how much or how little you or your insurance company pay me to see you, I will continue to do so. I will not abandon you because the reimbursement I get for your office visit is constantly diminishing or because I will soon get a bundled or quality-of-care payment rather than a fee for the service. No matter what the insurance scheme, I will struggle to lower office overhead to compensate for continued loss of income.
But Obamacare may not allow me to continue taking care of you, no matter how altruistic I am. The real problem with Obamacare’s narrow networks on the state exchanges is not doctors like me dropping out; it is insurers deciding not to add us to their new networks in the first place. Don’t get me wrong. No doctor in his or her right mind is eager to accept the reduced fees that Obamacare offers, and there is every reason to believe that the new policies will cut our reimbursements to the bone. But the reason that I don’t participate in the individual market’s GHI, HIP, or Empire Blue Cross plans is that these insurers have decided not to include my university’s network of doctors.
The cost of keeping us connected to our patients is far too rich for Obamacare’s blood. And for those insurers, like Oxford, United, and Aetna, that do include me via my university plan, I worry that these networks won’t include the orthopedist or kidney specialist or brain surgeon I am used to referring to, further jeopardizing my patient’s quality of health care. Can you imagine searching unsuccessfully for a brain surgeon to remove a growing tumor? This is the hideous future of the state exchanges: limited care provided by limited networks of physicians. Remember the “capitated” HMOs of the 1990s? Obamacare is a reprise of this failed model. The word “capitated” should really be “decapitated.”

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The individual market is just a taste of the future — the same problems are sure to surface when the Obamacare business exchanges are up and running. And as businesses drop employees’ health coverage or make them part-time, so that more individuals resort to the state exchanges, the numbers of patients who are used to seeing me but no longer can will increase dramatically.
Many of my fellow physicians are concerned that as Obamacare collapses without the good doctors to support it, the government will have no choice but to mandate that all doctors participate. There is already a precedent for this. With Medicare and Medicaid, you are either all the way in or all the way out. There is no middle ground. As a participating Medicare provider, I cannot refuse to see a Medicare patient, though I can certainly delay an elective visit when my office schedule is full. An AMA survey in 2010 found that 17 percent of doctors were restricting the number of Medicare patients in their practice. Can you blame them? With reimbursements falling and restrictions rising for performing complex procedures on elderly patients with multiple medical problems, what doctor would rush to see them?
Many of my brethren feel that the same problem will soon exist for Obamacare. This is many doctors’ worst nightmare. You see, Obamacare is a multi-headed beast — it involves too many insurers for such an across-the-board mandate to be effective or workable. Recently, I decided to drop out of an insurance network that was paying me only $25 per visit and was refusing to pay for flu vaccines.
I can’t imagine losing the right to drop out of a bad insurance network any more than I can imagine what would happen if the new Obamacare insurances could be forced to include the best doctors.
The health-insurance situation is bad enough without adding any more mandates.— Marc Siegel, M.D., is an associate professor of medicine at the NYU Langone Medical Center and medical director of the center’s Doctor Radio. He is a member of the Fox News Medical A Team and the author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health.